Healthcare Provider Details

I. General information

NPI: 1568762946
Provider Name (Legal Business Name): MS. ELISABETH THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/01/2010
Last Update Date: 11/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6613 N MERIDIAN AVE
OKLAHOMA CITY OK
73116-1423
US

IV. Provider business mailing address

12401 N MACARTHUR BLVD 2714
OKLAHOMA CITY OK
73142-3032
US

V. Phone/Fax

Practice location:
  • Phone: 405-603-8450
  • Fax:
Mailing address:
  • Phone: 405-650-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: